Provider Demographics
NPI:1356552731
Name:NICOLETTI, DARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 IVY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4965
Mailing Address - Country:US
Mailing Address - Phone:434-295-6880
Mailing Address - Fax:434-295-6811
Practice Address - Street 1:2214 IVY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4965
Practice Address - Country:US
Practice Address - Phone:434-295-6880
Practice Address - Fax:434-295-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics